Give $25 Drive Contribution Form

Dream Big! Use this form to give $25 or more to support important federation funds between May 16 and July 6 at 5:00 p.m. eastern time and be entered into the Dream Big: Give $25 Drive Drawing. Your name will be placed in the drawing for each increment of $25 you give. Give $100 and you will be entered into the drawing four times. It’s a win win!

New this year: You can be entered into an additional drawing to win a FREE Monarch dynamic tactile device thanks to HumanWare and APH. Be sure to check the box in the form below if you would like to be entered into this drawing.

Honorary Donations: If you are giving in honor of someone and would like that person to receive the prize if you win, please include their name and phone or email address in the field below.

How to Give: Please include your cell phone number and email address so we can contact you. Winner does not need to be present to win.

Please choose any of the funds to support. If you are not sure of a fund, please use the White Cane Fund. If you have questions, please contact [email protected].

Kenneth Jernigan Fund (to support first-time convention attendees and more):

tenBroek Fund (to support the Jernigan Institute building in Baltimore for the benefit of blind people):

SUN Fund (rainy day fund):

White Cane Fund (general donation fund):

Total Amount

Give 25 Donor Information

First Name *

Last Name *

Donor Email

Phone number (cell preferred)

Country

Street Address *

Street Address 2

City *

State

Postal Code *

Monarch Drawing

Yes, I would like the chance to win a free Monarch dynamic tactile device.

Giving in honor of someone? Enter name and email or phone number of the person designated to win the prize instead of you.

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *